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The use of case studies as a research
methodology has grown in recent years because of
the rapid changes in the health system today and
the inability of traditional data sources to answer
important questions. Many users of case study
information value the data, but are uncomfortable
with the small number of cases included in any
given study and the uncertainty associated with
interpreting the data. As more researchers pursue
this methodology, it is important to recognize that
numerous methodological strategies related to
implementing such research can enhance the
reliability and validity of the findings.

This report addresses a number of
methodological issues related to conducting case
study analyses. The first section discusses the
design of case studies: why they are done, the
importance of theory, defining and selecting cases
for study and designing the instrument for
gathering data.

The second section considers the analysis and
interpretation of qualitative data and describes the
"horizontal" logic at the core of case study
analysis. The use of data displays are described
and an example is included. This section also
describes the method of replication for analyzing
themes across multiple cases.

The Third Section of the paper considers issues
related to validity and reliability, and the final
section identifies a series of tensions inherent in the
case study methodology for researchers to consider
as they implement their work.

This report is not intended as a "how-to" for
con-ducting case studies, but rather is a recognition
of important points to be taken into account by
people conducting this kind of research and for
people who read the results.